Laparoscopic surgery is becoming increasingly popular with patients because the scars are smaller and the period of recovery is shorter. Laparoscopic surgery requires special training of the surgeon or gynecologist and the theatre nursing staff. The equipment is often expensive and is not available in all hospitals. During laparoscopic surgery, it is often required to shift the spatial placement of the endoscope in order to present the surgeon with an optimal view. Conventional laparoscopic surgery makes use of either human assistants that manually shift the instrumentation or, alternatively, robotic automated assistants (such as JP patent No. 06063003).
In laparoscopic surgery, the surgeon performs the operation through small holes using long instruments and observing the internal anatomy with an endoscope camera. The endoscope is conventionally held by a camera assistant since the surgeon must perform the operation using both hands. The surgeon's performance is largely dependent on the camera position relative to the instruments and on a stable image shown at the monitor; also the picture shown must be in the right orientation. The main problem is that it is difficult both for the assistant to keep the endoscope in the right spatial position, and for the assistant to hold the endoscope steadily, keeping the scene in the right orientation. To overcome these problems, several new technologies have been developed, using robots to hold the endoscope while the surgeon performs the procedure, e.g., Lapman, Endoassist etc. But these technologies are expensive, difficult to install, uncomfortable to use, limit the dexterity of the surgeon and have physical dimensions much larger that all the other operating tools. Relative to the required action, they also require a large region to be kept free for their movement and have several arms, moving around different axes. Another robot, LER (which was developed by the TIMC-GMCAO Laboratory), US. patent application Ser. No. 200/6100501 consists of a compact camera-holder robot that rests directly on the patient's abdomen and an electronic box containing the electricity supply and robot controllers. LER has relatively small dimensions but has a 110 mm diameter base ring that must be attached to, or be very close to, the patient's skin. This ring occupies a place over the patient's body, thus limiting the surgeon's activities: other trochars can not be placed there, whether or not the surgeon would prefer this, possibly changing the surgeon's usual method of carrying our the procedure, and sometimes forcing the setup process to be as long as 40 minutes. Also, the LER has only 3 degrees of freedom and is unable to control the orientation of the picture shown to surgeon (the LER cannot rotate the endoscope around its longitudinal axis).
However, even the improved technologies still limit the dexterity of the surgeon and fail to provide the necessary four degrees of freedom. Another disadvantage of these technologies is that they lack the ability to control fully both the spatial position of the endoscope tube and its orientation during the laparoscopic surgery, so that the surgeon may view any desired area within the working envelope in the body being operated on.
Therefore, there is still a long felt need for a camera holder that will hold the endoscope steady and that will allow full control of the endoscope in all four degrees of freedom, without limiting the dexterity of the surgeon. Furthermore, there is also a long felt need for a camera holder that will provide the ability to control the spatial orientation of an endoscope tube, so that the surgeon may reach any desired area within the working envelope in operated body and may view that area from any desired angle.